Vol 20, No 9 (2018)
Articles
Results of a pilot study of microRNA in patients with ischemic stroke
Abstract
Actuality. The high medical and social significance of ischemic stroke determines the search for new diagnostic and prognostic biomarkers, which can be microRNAs - non-coding RNAS of small length, which suppress the expression of protein-coding genes. Until now, no studies of the levels and role of microRNAs in patients with ischemic stroke have been conducted in Russia. The aim was to determine the levels of microRNA-21, 125, 126, 145 in plasma and buccal scraping in patients with ischemic stroke. Materials and methods. The study included 36 patients with acute ischemic stroke. A biomaterial for the study of microRNA-21, 125, 126, 145 in EDTA-plasma and bukkalno scrapings were taken on the 1st and 4th day from the beginning of the development of the disease. Determination of the level of microRNA included the stages of isolation, reverse transcription and real-time PCR. Statistical processing of the study data was carried out using software SPSS 8.0, Microsoft Excel 2013. Results. Statistically significant dynamics by 4 days of observation in patients with AI was revealed by levels of microRNA-125 in plasma, microRNA-126 in scraping and microRNA-145 in scraping. There were also statistically significant differences in the level of microRNA-126 in 1 and 4 days, and microRNA-125 in 4 days of observation. The development of the lethal outcome revealed statistically significant differences in the level of miRNA-125 in buccal scraping on 1 day, miRNA-145 in buccal scraping on 1 day and microRNA-21 in plasma on 1 day of observation. Also, the differences in such complications as pneumonia, pulmonary embolism, pyelonephritis. There were no statistically significant differences in the levels of miRNAs by type of AI, as well as by the presence and type of hemorrhagic transformation. Conclusion. MicroRNA-21, 125, 145 for 1 day of observation from the development of AI may have significance in the prognosis of fatal outcome, microRNA-21, 125 for 1 day in the forecast for the development of pneumonia, microRNA-125 for 1 day - the forecast PE, microRNA-126 on the 4th day - in the prediction of pyelonephritis. The revealed absence of differences in levels of microRNA-21 and 125 in scraping and plasma is a possible basis for the application of a non-invasive method of taking biomaterial for the study of microRNA.
Consilium Medicum. 2018;20(9):8-11
8-11
Possibilities for rehabilitation program for patients in acute period of ischemic stroke optimization
Abstract
An optimized rehabilitation program for patients in acute period of ischemic stroke that includes early activization, mechanotherapy and cognitive stimulation with the use of tablet technologies and computer programs for memory, attention, perception, and count improvement resulted in statistically significant improvement of patients’ functional activity according to modified Rankin scale and Barthel index of activities of daily living at the end of training program performed during the hospital stay. Improvement was observed after 3 and 6 months of follow up. A statistically significant change in neuropsychological test results according to Montreal cognitive assessment scale and DigitSpan subtest of Wechsler scale was reported. The proposed program for stroke rehabilitation optimization that includes mechanotherapy and cognitive stimulation with the use of tablet technologies is effective, accessible and easy to use and is performed with minimal participation of healthcare staff at the beginning of the course. Later patients can practice independently. No adverse effects were observed during the study period.
Consilium Medicum. 2018;20(9):12-16
12-16
Tactics of the speech therapist’s work and the choice of clinical nutrition for the patient with swallowing disorders after the stroke (clinical case)
Abstract
The purpose of this article to show a dysphagia as a widespread problem in neurological practice; importance of recovery methods of speech therapy; functional techniques of neurogenic dysphagia rehabilitation; to give quality standard of the applied clinical oral food at a dysphagia.
Consilium Medicum. 2018;20(9):17-21
17-21
Strategies of cerebral small vessel disease early diagnostics and therapy
Abstract
Sporadic cerebral small vessel disease is one of the most widespread pathologic processes that has an essential role in stroke and cognitive decline development and at the same time it is a systemic disorder that affects other organs. The search for optimal medications for small vessel disease prevention and treatment is still going, new studies that will result in new treatment strategies development have emerged. At present the priority for background therapy use (antiplatelet, antihypertensive, statin therapy) is preserved.
Consilium Medicum. 2018;20(9):22-29
22-29
Botulinum toxin type A (incobotulinotoxin A) use in a patient with post-stroke upper limb spasticity: clinical case report
Abstract
Spasticity syndrome is registered in 19-38% of patients after stroke. Botulinum toxin type a is a priority method of post-stroke spasticity therapy to expand the rehabilitation potential. The article illustrates a clinical observation of therapeutic effect of injections incubatoarele and with post-stroke spasticity of the upper limbs. The position of the hands with spasticity corresponded to figure III (H.Hefter). The key muscles for injection were determined by testing active and passive movements performed at different speeds and in different positions of the arm and its parts for each muscle pattern, which led to the diagnosis of spasticity in the chest, biceps, shoulder, shoulder muscles, circular pronator, superficial and deep finger flexors. Injection accuracy and functional muscle activity were monitored by ultrasound and needle electromyography. Prior to therapy and to monitor its effectiveness, motor functions of the upper limb were evaluated on the following scales: Fugl-Meyer, ARAT, Barthel Index, Ashworth scale, Rankine scale, British muscle strength assessment scale with positive results.
Consilium Medicum. 2018;20(9):30-33
30-33
Clinical case: cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Abstract
The article presents a clinical case of a female patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). A literature analysis results and information on etiology, clinical presentation and pathogenesis of the disease are given. In our clinical case CADASIL in a 56 year old woman was verified with molecular genetic testing. The diagnostic challanges are in simularity of clinical manifestations in small vessel disease group. With increase of CADASIL awareness data on its prevalence and disease course will be specified thal will allow development of more rational methods for detection of these patients from the leucoencephalopathies group.
Consilium Medicum. 2018;20(9):35-38
35-38
Practical use of non-steroid anti-inflammatory drugs in cephalgia treatment: clinical and scientific evidence review
Abstract
В неврологической практике нестероидные противовоспалительные препараты (НПВП) широко используются в терапии скелетно-мышечных вертеброгенных болевых синдромов. В то же время отмечаются сложности в определении необходимости и точек эффективного применения НПВП при разных формах головных болей, особенно при мигрени. Современные экспериментальные данные показывают, что обезболивающий эффект НПВП связан не только с периферической аналгезией, но и с действием на уровне заднего рога спинного мозга, нейронов ядра тройничного нерва. Эти механизмы могут объяснять эффективность НПВП при мигрени. В обзоре обсуждается место НПВП при различных головных болях, преимущества по профилю эффективность/безопасность быстродействующих форм НПВП, стратифицированный подход к обезболиванию.
Consilium Medicum. 2018;20(9):39-46
39-46
Benign paroxysmal positional vertigo: modern approach to clinical presentation, diagnostics and treatment
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder characterized by spontaneous remissions several days or weeks after the onset of the disease and frequent relapses. In BPPV, dizziness of a systemic nature (vestibular or true) occurs when the position of the head changes (turning in the bed, tipping the head backwards or tilting forward) and lasts, as a rule, no more than 1 min. Daily vestibular attacks of BPPV can last from several days to several years. The main cause of development of BPPV is otolithiasis. Diagnosis of BPPV is determined by the results of positional tests. Treatment in the form of specific exercises (maneuvers) rarely requires prolonged drug support. With poor tolerance of maneuvers (bright vestibular-vegetative symptoms in the form of rotational vertigo with nausea and vomiting), it is justified to use vestibular suppressants.
Consilium Medicum. 2018;20(9):47-50
47-50
Therapeutic potential of glycosaminoglycan-peptide complex injectable form use in knee osteoarthritis treatment according to PRIMULA (Use of Rumalon with initially small success in the treatment of osteoarthritis) study results: supplemented data
Abstract
Slow-release anti-inflammatory agents (SRIA) are widely used in osteoarthritis (OA) treatment. One of common medications of this group is a glycosaminoglycan-peptide complex - GPC (Rumalon®) that is designed for parenteral course use. GPC has a complex therapeutic effect; it suppresses pain and inflammation, and slows down OA progression. Study objective - to determine therapeutic effect and frequency of adverse events (AE) of GPC use in patients with knee OA in whom other SRIA showed low efficiency. Materials and methods. GPC Rumalon® was used in 115 patients (92.3% female, aged 63.6±8.6 years, body mass index 29.8±5.4 kg/m2), who suffered fr om significant joint pain (≥40 mm on 100 mm visual analogue scale - VAS) and needed regular use of nonsteroidal anti-inflammatory drugs (NSAD). All patients received oral SRIA in the last 6 months. At the time of treatment onset pain severity according to VAS was 59.9±15.3, WOMAC pain index -236.5±94.7, WOMAC stiffness - 101.8±43.8, WOMAC function - 806.7±349.4, WOMAC total - 1144.9±459.1. GPC was used according to manufacturer’s recommendations: 25 intramuscular injections were performed on alternate days in each patient. Effectiveness criteria included pain severity (VAS) and WOMAC index dynamics, NSAD use reduction, and patents’ personal assessment of the treatment results (on the scale 1-5 wh ere 1 - no improvement or deterioration and 5 - excellent results). The measures were estimated 8 and 12 weeks after the start of the study. Results. In 8 and 12 weeks pain severity (VAS) decreased by 29.0±17.6% and 34.6±16.2%, WOMAC pain index decreased by 29.6±15.8% and 37.2±21.7%, WOMAC stiffness - by 27.7±14.8% and 30.4±16.7%, WOMAC function - by 27.4±13.9% and 30.0±17.1%, WOMAC total - by 26.9±12.8% and 32.4±17.4%, respectively. The measures dynamics was statistically significant compared with the baseline (p<0.001). After 8 and 12 weeks of treatment 79.6% and 75.6% of patients estimated treatment results as good and excellent. After 12 weeks of treatment 31.7% of patients discontinued NSAD use, 32.4% lowered the dose or changed to NSAD use on demand. AE were reported in 1.8% of patients. AE development did not require GPC treatment course interruption, AE were corrected without further consequences after the end of treatment. Conclusion. GPC Rumalon® use allows to reduce pain and inflammation severity and functional impairment, as well as NSAD demand in OA patients including patients with severe disease progression and low effectiveness of pre-study therapy.
Consilium Medicum. 2018;20(9):51-57
51-57
The case of transthyretin familial amyloid polyneuropathy: diagnostic search
Abstract
Transthyretin familial amyloid polyneuropathy (TTR-FAP) is rare hereditary degenerative disease. It is based on the deposition of amiloid in the peripheral nerves, which leads to axonal degeneration. The disease is demonstrate steadily progressing sensomotor and autonomic polyneuropathy. In non-endemic regions and in the absence of a family history, the diagnostics is very difficult and it takes a long time. Most often it is difficult to make a differential diagnosis between TTR-FAP and chronic inflammatory demyelinating polyneuropathy. The case of TTR-FAP in a patient with a genetically confirmed mutation Phe53Leu in the gene of transtyretin shows a diagnostic search for a given disease.
Consilium Medicum. 2018;20(9):58-62
58-62
Effectiveness of Theraflex® evaluation in early stages of osteoarthritis treatment and its influence on articular cartilage structure and metabolism
Abstract
Rationale. The main concern of early stages osteoarthritis treatment is finding pathogenically justified medications. An important role of inflammatory and destruction components in the disease development induces necessity for modern combined cartilage protectors effectiveness study. Objective. To evaluate effectiveness and safety of combined symptomatic medication with delayed effect Theraflex® use in osteoarthrosis treatment according to clinical symptoms, physical examination, and biochemical tests of connective tissue metabolism parameters. Materials and methods. Biochemical values of connective tissue matrix destruction and electrolytes values were evaluated in serum and urine samples of 44 patients (22 patient from group 1 in whom standard treatment combined with Theraflex® was used and 22 patients in whom only standard treatment was used). Also X-ray imaging was performed and functional severity of osteoarthrosis and pain syndrome were evaluated. Results. Effectiveness of Theraflex® use in early stages of osteoarthritis treatment was shown from the perspective of its influence on arthrodial cartilage structure and metabolism. The conducted biochemical studies of serum and 24-hour urine allowed to establish that after Theraflex® use the connective tissue biopolymers metabolism parameters return to normal. The study of clinical and radiological results of Theraflex® use in osteoarthritis patients indicates its positive effect after short term use. Conclusions. The conducted study proved symptom- and structure-modifying drug effect of the medication that was shown in sonographic and radiologic characteristics of articular cartilage and subchondral bone. Improvement of connective tissue metabolism biochemical characteristics allows us to recommend the medication use in early stages osteoarthritis treatment.
Consilium Medicum. 2018;20(9):63-70
63-70
Dexketoprofen: therapeutic potential in neurology
Abstract
At present non-steroid anti-inflammatory drugs (NSAID) remain the basis for acute pain syndrome of any intensity treatment. In clinical neurologysts' practice NSAID are mostly used in musculoskeletal system disorders treatment and for headaches abortion. The concern is to choose a right medication for the patient considering all indications and contraindications, to determine an adequate dosage or a combination of several analgetic drugs. In the meantime it is recommended to use medications with maximal rate of analgesic effect development and minimal risk of adverse effects in gastrointestinal tract development without loss of effectiveness. Dexketoprofen trometamol, a dextrarotatory isomer of ketoprophen, is one of these medications from NSAID group. The drug is highly purified from R(-)-ketoprophen (99.9%), and has improved physico-chemical properties. The article describes its mechanisms of action, and presents clinical studies results that demonstrate dexketoprofen trometamol (Dexalgin®) analgetic effectiveness and tolerance with the primary indication for use in neurology in musculoskeletal pain and migrainous headaches treatment.
Consilium Medicum. 2018;20(9):71-75
71-75
Pulse wave velocity and other indicators of arterial stiffness in patients with ankylosing spondylitis during the daily monitoring procedure
Abstract
In recent years the increased arterial stiffness in ankylosing spondylitis (AS) was shown. However this issue has not been adequately studied nowadays. Objective - to evaluate the readings of central aortic pressure and pulse wave velocity (PWV) and their relationship with AS during ambulatory (daily) monitoring. Materials and methods. 49 patients with ankylosing spondylitis were examined. This group included 38 men, 11 woman, mean age was 39.4±11.3 years old. Ankylosing Spondylitis Disease Activity Score was 3.11±0.55. The control group included 20 healthy individuals. The groups were similar in age and sex. The daily (ambulatory) monitoring of the peripheral, central aortic pressure and the vessel stiffness data was made by BPLab version 3.2 with Vasotens technology. We compared the groups with distribution-free statistical method. Results. The mean systolic and diastolic pressure with in the brachial artery, office blood pressure values and heart rate were similar in both groups. The ankylosing spondylitis group demonstrated the increase in the mean values of the central aortic pressure in comparison with the control group. The minimum, medium and maximum PWV were higher in the patients with ankylosing spondylitis by 7.44, 15.8 and 26.2%, respectively. Ambulatory Arterial Stiffness Index and Reflected Wave Transit Time were higher in the patients with ankylosing spondylitis by 59.1 and 8.1%, respectively. Subendocardial viability ratio (SEVR) was lower in the patients with ankylosing spondylitis in comparison with the control group. During daily monitoring of the aortic blood pressure the non-dipper type (57.2%) dominated in the patients with ankylosing spondylitis. Medium PWV per day was directly correlated with total cholesterol levels (r=0.41; p=0.026). SEVR maximum per day was negatively correlated with X-ray stage of sacroiliitis (r=0.38; p=0.008). Medium SEVR per day was negatively correlated with C-reactive protein - CRP (r=-0.40; p=0.017), and with ASDAS-CRP (r=-0.43; p=0.003). Smoking history was directly correlated with minimum aortic systolic blood pressure per day (r=0.49; p=0.044), medium aortic systolic blood pressure per day (r=0.52; p=0.032), minimum aortic pulse pressure per day (r=0.55; p=0.021), aortic augmentation pressure (r=0.62; p=0.017). Conclusion. Increasing indicators of arterial stiffness were determined in patients with AS. The relationship between clinical and laboratory data and arterial stiffness parameters was demonstrated. The aortic non-dipper type was dominated in the patients with AS.
Consilium Medicum. 2018;20(9):76-81
76-81
Vitamin D deficiency: skeletal and non-skeletal disorders and its treatment with alfacalcidol
Abstract
The article presents data on physiological role of vitamin D and primary causes of its deficiency. Aspects of native and active vitamin D forms metabolism including its dependence on age and comorbid conditions are discussed. Primary indications for active vitamin D metabolites prescription are described. It is noted that compared with native vitamin D alfacalcidol demonstrates better clinical effectiveness in different types of osteoporosis treatment due to the absence of its metabolism in kidneys and the safety profiles of the medications are similar. Unlike native vitamin D alfacalcidol monotherapy is included in clinical recommendations for this disorder treatment as it demonstrated better effectiveness in bone mineral density increase, risk of falls and fractures reduction, as well as significant relief of pain syndrome. Broad opportunities of Alpha D3-Teva® individual dosage (alfacalcidol) allow to minimize risk of adverse effects development that together with new fractures prevention, pain syndrome reduction and motor activity improvement results in quality of life of patients of all ages improvement.
Consilium Medicum. 2018;20(9):82-87
82-87
Non-steroidal anti-inflammatory drugs use in clinical practice: new opportunities
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are considered safe and effective analgesics. These medications effectively reduce pain syndrome and suppress local inflammation but unfortunately may cause a wide range of adverse effects. Although there are 28 different NSAIDs registered in Russia (and many of them have dozens of generics), none of them can be considered ideal in terms of effectiveness and safety. It explains development of new drugs in this group. Nowadays tenoxicam is again included in clinical use in Russia. This medication is well known all over the world. Tenoxicam effectiveness and safety were acknowledged in many clinical trials. And its use in clinical practice for many years is the main test that the drug has successfully passed. Opportunities of tenoxicam therapeutic use were shown in patients with rheumatoid arthritis, ankylosing spondylitis and gout. It allows to successfully reduce pain in patients with most common rheumatic disorders such as osteoarthritis and non-specific back pain. Tenoxicam proved to be an effective component of combined perioperative anesthesia in surgical practice. It is also effective for pain relief in urgent situations such as acute injuries, toothache, renal or gallstone colic. Tenoxicam is administered once a day, it has different pharmacological forms and a favorable safety profile. Undoubtedly, tenoxicam inclusion in clinical practice increases opportunities of analgesic therapy in practical use for various medical professionals.
Consilium Medicum. 2018;20(9):88-94
88-94
Tremor: classification, clinical characteristic
Abstract
In this review, a new principle for the classification of various tremor types, mechanisms of tremorogenesis, and the main clinical characteristics of trembling hyperkineses are presented. New criteria for the diagnosis of essential tremor, the most common extrapyramidal disease characterized by the development of trembling hyperkinesis, are presented. The main manifestation of essential tremor is the kinetic and postural (kinetically-postural) tremor, involving more often both the arms, the head, the vocal cords, and rarely other parts of the body. In the article criteria of differential diagnostics of different types of tremor are given: parkinsonian, dystonic, primary writing tremor and others.
Consilium Medicum. 2018;20(9):95-100
95-100
Algorithm of antidepressants use in clinical practice
Abstract
According to the World Health Organization data mixed anxiety and depressive disorder (MADD) and stroke are one of the ten most important healthcare problems. Anxiety symptoms and subsyndromal MADD are found in 76% of the world's population. Depression that internal medicine specialists come across in everyday practice mostly exists in an atypical latent form and is masked with various psychovegetative, algesic and somatic manifestations. Pain syndrome is always combined with various psychopathologic and psychovegetative complaints. The basis therapy includes antidepressant medications that are indicated not only when autonomic disturbances are symptoms of depression but also when they are a part of anxiety and anxiety-phobic disorders even if there is no evident depression.
Consilium Medicum. 2018;20(9):101-107
101-107
Neuromethabolic therapy in patients with chronic cerebrovascular disorders
Abstract
Cerebrovascular diseases - the main cause of death and persistent disability. Prevention of cardiovascular diseases is the most effective way to solve the problem of vascular lesions of the brain. In the case of an already developed vascular lesion of the brain, an improvement in the outcome of the disease can be achieved by including neurometabolic drugs in the complex therapy. The clinical effects of L-carnitine (Elkar) in patients with acute and chronic cerebral ischemia are considered. It is noted that the maximum effect of its use can be achieved with the simultaneous use of non-drug treatment and adequate drug therapy.
Consilium Medicum. 2018;20(9):108-112
108-112
New methods of chronic pain pharmacotherapy
Consilium Medicum. 2018;20(9):113-117
113-117